Moorabbin Hospital

To investigate the prevalence and severity of pelvic floor disorders (PFD), and the associations between treatment type and PFD, and cancer stage and PFD in patients before and after hysterectomy for gynaecological cancer; and the changes in outcomes over time. Longitudinal cohort study. Gynaecological oncology outpatient clinics. Patients undergoing hysterectomy for endometrial, uterine, ovarian or cervical cancer. Participants were assessed before, and 6 weeks and 3 months after hysterectomy. Changes over time were analysed using generalised estimating equations or linear mixed models. Associations were analysed using logistic regression models and analyses of variance. Incontinence Severity Index, Pelvic Floor Distress Inventory-short form (PFDI-20), Female Sexual Function Index. Of 277 eligible patients, 126 participated. Prevalence rates of PFD were high before (urinary incontinence [UI] 66%, faecal incontinence [FI] 12%, sexual inactivity 73%) and after (UI 59%, FI 14%, sexual inactivity 58%) hysterectomy. Receiving adjuvant therapy led to moderate-to-very severe UI 3 months after surgery compared with surgery only (odds ratio 4.98, 95% CI 1.63-15.18). There was no association between treatment type and other PFD, or cancer stage and any PFD. Prevalence of PFD was high before and after hysterectomy for gynaecological cancer. Moderate-to-very-severe UI was associated with adjuvant therapy.

The objectives of this study were to report the complications in radial and ulnar diaphyseal fractures in cats and to compare the differences in outcome between single and dual bone internal fixation. Medical records between 2004 and 2022 were searched retrospectively for cats with antebrachial diaphyseal fractures treated with internal bone-plate fixation. In total, 49 cases were included from six referral hospitals, including one teaching hospital. Patient information was collated, including fracture configuration, location, repair method and clinical outcome as assessed by veterinary physical examination, radiography and owner questionnaire. A total of 47 cats (mean age 4.2 years) were included. Fractures were located distally (24/49, 49%), proximally (13/49, 26.5%) and mid-diaphyseally (12/49, 24.5%). Dual bone fixation was used in 13/49 (26.5%) cases, with only 1/13 (7.7%) having major complications. By comparison, 4/36 (11.1%) of single plated fractures had major complications. Single bone fixation was 14.25 times more likely (95% confidence interval [CI] 2.07-97.99) to have a successful outcome (veterinarian-assigned score of 0) compared with dual bone fixation (P = 0.007). When evaluating owner-assessed outcomes, single bone fixation was 9.4 times more likely (95% CI 1.4-61.96) to have a successful outcome (owner score of 0) compared with dual bone fixation (P = 0.019). Fractures that were repaired with single bone fixation had a greater chance of a better outcome. Although the difference was not significant, there was a higher major complication rate and a lower minor complication rate for cases treated with single bone fixation compared with dual bone fixation. The majority of fractures were located in the distal diaphysis. Comminution of the fracture and concurrent orthopaedic issues did not significantly affect the outcome. Further prospective studies with standardised follow-up, radiographic assessment, surgeon and implants are required to truly assess the difference between dual and single bone fixation.

Topic: 31. Transfusion medicine Background: No standardized or universally accepted definition for massive transfusion (MT) currently exists, making it difficult to compare safety and efficacy data across studies on critically bleeding patients. The Bleeding Academic Research Consortium successfully standardized definitions for major bleeding in both surgical and non-surgical patients, providing proof of principle for a similar approach to be adopted for the definition of MT. Aims: To identify and evaluate all MT definitions used in randomized controlled trials (RCTs) to date to inform the development of an international consensus definition for MT. Methods: We performed a scoping review of RCTs related to MT. MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Cumulative Index to Nursing and Allied Health Literature, and Transfusion Evidence Library were searched from inception until 11 August 2022 without language restriction. Ongoing trials were sought from CENTRAL, ClinicalTrials.gov, and World Health Organisation International Clinical Trials Registry Platform. To be eligible for inclusion, studies were required to: (1) be an RCT; (2) include an adult patient population with an acquired bleeding disorder who had received, or were anticipated to receive, an MT in any clinical setting; and (3) have a specified definition for MT. Conference abstracts, opinion pieces, clinical guidelines, narrative reviews, post hoc analyses, laboratory-only studies, and studies including only paediatric or non-human subjects were excluded. Results: Of the 8,460 distinct references identified from the initial search, 30 studies were included (19 published, 11 ongoing). Several landmark trials on critically bleeding patients, including CRASH-2, were excluded as they did not report a definition for MT. Table 1 highlights the lack of uniformity in MT definitions used to date. Fifteen distinct definitions of MT have been used in RCTs across 4 different specialties (trauma, obstetrics/gynecology, cardiothoracic surgery, and orthopedic surgery) since 1986. Most were based on number of units of RBCs or whole blood administered within a certain time interval. None included other blood products (e.g., platelets, plasma), and some did not specify a time interval during which administration needed to take place. The most common definition of MT (featuring in 10/30 = 33% of studies) was the classic definition of ≥10 units of RBCs in 24 hours (h), with a trend in more recent studies towards the use of shorter time frames (e.g., ≥4 RBCs in 6 h in the TrauCC study registered in 2016 and T-STORHM study published in 2019; ≥3 RBCs in 1 h in a Spanish trial registered in 2017 and the PROCOAG study published in 2021). The classic definition (≥10 RBCs in 24 h) was favored in trauma (featuring in 9/15 = 60% of trauma trials), whereas the most frequently used definition in obstetrics/gynecology was >5 units of whole blood (featuring in 3/6 = 50% of obstetrics/gynecology trials). Summary/Conclusion: Significant heterogeneity exists in the definitions used for MT in RCTs to date. Our findings provide a basis for the development of a consensus definition for MT (e.g., through a modified Delphi process) that can be applied consistently across future trials, which balances the strengths and weaknesses of previous definitions in a specialty-specific manner.Keywords: Transfusion, Bleeding, Blood transfusion

Interprofessional learning (IPL), where nursing students learn how to work with multiple health professionals in their future practice to deliver the highest quality of care, has become an essential feature of undergraduate nursing programs. Intraprofessional learning (IaPL) is where individuals of two or more disciplines within the same profession collaborate; however, there is a dearth of literature investigating its effects in nursing education. The aim of this study is to investigate the impact of IaPL on the development of nursing students’ knowledge, skills, and attitudes for collaborative practice. The study will utilize a mixed methods approach with surveys conducted at six time points across two years of two nursing programs and focus groups at the end of the program. Participants will be recruited from the Diploma and Bachelor of Nursing programs at an Australian Training and Further Education institute. Four specific IaPL educational experiences incorporating simulation will be developed on aged care, mental health, complex care and acute care. The study will provide nursing students with multiple opportunities to develop the necessary capabilities for collaborative practice. It will longitudinally evaluate nursing students’ attitudes towards IaPL and examine whether IaPL motivates Diploma of Nursing students to pathway into a Bachelor of Nursing degree. The study will also investigate awareness amongst nursing students of the scope of practice, roles and responsibilities of the nursing team.

We report a case of a 45-year-old female who developed multi-focal encapsulated papillary carcinoma (EPC) in her left breast. This was on a background of previous left breast high-grade ductal carcinoma in situ, for which she had a skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) reconstruction five years ago. Papillary carcinoma is a rare pathology, and its occurrence in autologous breast reconstruction is even rarer. This is the second reported case of papillary carcinoma in a DIEP reconstruction. Although surgery remains the gold standard for EPC, debate remains with regard to adjuvant endocrine therapy and radiotherapy. We discuss the diagnosis and current management of an EPC.

Abstract Introduction Iron oxide nanoparticles have been used in preclinical and clinical research as imaging agents for decades because of their magnetic properties and their known safety profile. We have been developing the MagSense® HER2 Test Reagent (MSH2TR), a formulation of anti-human epidermal growth factor receptor 2 (HER2) conjugated iron oxide nanoparticles, for the noninvasive detection of metastatic lymph nodes to aid in staging of HER2 positive (HER2+) breast cancer patients. Currently, nodal staging requires a patient’s lymph nodes to be surgically removed or biopsied for histopathological examination. MSH2TR is currently being investigated in a first-in-human phase I study in subjects with HER2+ primary breast cancer who, in the judgment of the investigator, have a likelihood of lymph node metastasis. Methods This phase I study is designed to be a preliminary proof-of-principle study with the primary objective of achieving an initial assessment of the safety and tolerability of the MSH2TR injectable imaging agent. A secondary objective of the study is the confirmation that the route of administration is effective in allowing the imaging agent to reach the patient’s lymph nodes. The exploratory objectives of the study include a comparison of the two imaging modalities: magnetic resonance imaging (MRI) and a novel proprietary technology called magnetic relaxometry (MRX), to standard clinical tissue histopathology. The exploratory objectives are expected to provide a preliminary assessment as to whether the MagSense® HER2 imaging agent, when used with one or both imaging modalities, might be able to provide a non-invasive alternative to nodal biopsy. All eligible subjects receive a 30mg injection of MSH2TR into the subareolar interstitial tissue or area near and around the primary tumor. MRI of the axilla are performed before and 24 to 72 hours after MSH2TR injection followed by core biopsy or dissection of the suspected lymph node tissue as per standard of care (SOC) procedures for histopathology assessments and also for ex vivo MRX measurements using the MagSense® Relaxometry Instrument. Review of the MRI scans and histopathology are performed in respective central laboratories. The study is currently enrolling in 4 clinical sites in Australia. Results From an interim evaluation of the first five patients that have completed the study, MSH2TR appears to be safe and well tolerated and no safety issues reported related to the imaging agent. The imaging agent, as administered, is reaching the lymph nodes. The study intends to enroll approximately 15 patients for the preliminary efficacy assessment. Safety and efficacy results from available patients’ data will be presented. Conclusion Available data to date from the ongoing phase I study show that the MagSense® HER2 imaging agent, as administered, appear to be safe and drains to the axillary lymph nodes within the timeframe of interest. Further data collection is ongoing for the preliminary evaluation of efficacy. Citation Format: Yalia Jayalakshmi, Jane Fox, Natalie Yang, Marie Zhang, Robert Proulx, Steven Reich. Noninvasive Detection of Lymph Node Involvement in Subjects with Human Epidermal Growth Factor Receptor 2 Positive (HER2+) Breast Cancer using the MagSense® HER2 Test Reagent – A First-In-Human Phase 1 Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-09-02.

Symptoms of either female sexual dysfunction (FSD) or urinary incontinence (UI) after breast cancer treatment are reported to be common. Despite this, the prevalence and severity of FSD in women who experience UI after breast cancer treatment has not been investigated. The aim of this study was to compare the prevalence and severity of FSD in women with and without breast cancer who experience UI. A secondary analysis of data from a larger cross-sectional study was undertaken. 21 pairs of sexually active women with and without breast cancer who experienced UI were matched according to age, body-mass index and parity. The severity of FSD was assessed using the Female Sexual Function Index (FSFI). Participant demographics, prevalence of FSD, and FSFI scores were reported descriptively. Differences in prevalence rate of FSD and FSFI scores between women with and without breast cancer and UI were analysed using Wilcoxon signed-rank or McNemar’s tests. Participants with breast cancer who experienced UI reported significantly higher rates of FSD ( n = 19/21, 90%) compared to participants without breast cancer with UI ( n = 10/21, 48% p = 0.0028). Participants with breast cancer and UI had a significantly lower overall FSFI score (median = 18.8, IQR = 12.5) compared to those without breast cancer with UI (median = 25.9, IQR = 10, p = 0.0096). They also reported lower arousal, less lubrication, lower satisfaction and more pain during sexual activity compared to participants without breast cancer who experienced UI. Participants with breast cancer who experienced UI had a higher prevalence and severity of FSD than participants without breast cancer with UI. They reported having lower arousal, lubrication, satisfaction and more pain during sexual activity. These preliminary results suggest larger studies to investigate sexual function in women with breast cancer and UI are warranted.

Virtual communities of practice consist of individuals who use a common online platform to share professional expertise and experiences. In healthcare settings a virtual community of practice (VCoP) can optimise knowledge, skills, and the implementation of evidence-based practice. To ensure effective knowledge synthesis and translation into practice, it is essential to clarify the best methods for designing and implementing VCoPs within healthcare organisations. This scoping review aimed to identify the methods used to establish and facilitate online or digitally enabled communities of practice within healthcare organisations across the globe. Six online databases identified papers published from January 2010 to October 2020. Papers were independently screened by two reviewers using Covidence. Data were captured and analysed using a data extraction chart in Covidence. Twenty-four publications that detail methods for establishing a VCoP in healthcare were included. Few studies used a framework to establish a VCoP. It was difficult to identify details regarding methods of development and key elements such as roles, how they were coordinated, and types of technology used. Healthcare organisations can benefit from using a standardised framework for the establishment, implementation and evaluation of VCoPs to improve practice, staff engagement, and knowledge sharing.

Despite significant scientific advances in the modern three-piece inflatable penile prosthesis implant surgery, it is not without surgical risks and can carry additional cosmetic and psychosocial consequences in poorly selected and consented individuals. To address this problem, an international group of key opinion leaders and high-volume prosthetic surgeons reviewed the current guidelines and clinical evidence, discussed their experiences, and formed a consensus regarding inflatable penile prosthesis surgery. The findings of this consensus panel were presented at the 17th biennial Asia Pacific Society of Sexual Medicine scientific meeting. The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes. Furthermore, most intraoperative complications, if recognized, can be addressed intraoperatively to enable placement of the device at the time of initial surgery. Men with significant corporal fibrosis due to Peyronie's disease, prior prosthesis explantation and priapism, and men who have undergone construction of a neophallus, as well as men who receive concurrent continence surgery, are complex cases requiring additional care and advanced techniques to obtain optimal surgical outcomes. Variability in patient care - in terms of postoperative antibiotic use, pain management, scrotal care, and cycling of the penile prosthesis implant - must be reduced to enable optimization and assessment of outcomes across patient groups.